高压氧联合温控射频热凝术治疗原发性三叉神经痛49例疗效观察

Observation on the therapeutic effect of hyperbaric oxygen combined with temperature-controlled radiofrequency thermocoagulation in the treatment of 49 cases of primary trigeminal neuralgia

目的探讨高压氧联合温控射频热凝术治疗原发性三叉神经痛的临床疗效及其作用机制。方法选择2020年1月至2021年1月河南大学淮河医院神经内科住院治疗的原发性三叉神经痛患者98例作为研究对象。采用随机数字表法将患者分为对照组和联合组,每组49例。对照组采用温控射频热凝术治疗,联合组采用高压氧联合温控射频热凝术治疗。在术后7、14、90、180 d对患者进行住院或门诊随访。采用视觉疼痛模拟评分(VAS)对患者疼痛程度进行评定,并计算临床优良率。采用简化马克吉尔疼痛问卷(SF-MPQ)评估患者不适程度。应用酶联免疫吸附法检测患者血清干扰素-γ(IFN-γ)、白细胞介素(IL)-4、IL-10的表达水平。应用全自动电化学发光仪检测血清神经元特异性烯醇化酶(NSE)的表达水平。记录2组患者术后咀嚼肌无力、面部感觉减退等并发症的发生情况。结果与治疗前比较,2组患者治疗后VAS、SF-MPQ评分均明显降低(P<0.01);联合组治疗后7 d和180 d VAS、SF-MPQ评分均明显低于对照组(P<0.05)。联合组治疗后14 d和180 d临床优良率明显高于对照组(P<0.05)。联合组患者治疗后7、14、90 d咀嚼肌无力发生率低于对照组,而联合组患者在治疗后14、90 d面部感觉减退发生率低于对照组(P<0.05)。与治疗前比较,2组患者治疗后血清IFN-γ水平明显升高,IL-4、IL-10和NSE水平明显降低(P<0.01);联合组患者治疗7 d后血清IFN-γ水平明显高于对照组,IL-4、IL-10和NSE水平明显低于对照组(P<0.05)。结论高压氧联合温控热凝术治疗原发性三叉神经痛起效快、维持时间长,能够明显减轻患者的疼痛程度及不适程度,并能降低患者面部感觉减退程度和咀嚼肌无力等并发症的发生率,值得临床推广应用。

Objective To investigate the clinical efficacy and mechanism of action of hyperbaric oxygen combined with temperature-controlled radiofrequency thermocoagulation in the treatment of primary trigeminal neuralgia.Methods A total of 98 patients with primary trigeminal neuralgia hospitalized in the Department of Neurology of Huaihe Hospital of Henan University from January 2020 to January 2021were selected as the study subjects.The patients were randomly divided into control group and combination group,with 49 patients in each group.The control group was treated with temperature-controlled radiofrequency thermocoagulation,while the combined group was treated with hyperbaric oxygen combined with temperature-controlled radiofrequency thermocoagulation.Inpatient or outpatient follow-up visits were conducted 7,14,90,and 180 days after surgery.The visual pain simulation score(VAS)was used to assess the pain degree and calculate the excellent and good rate of clinical efficacy.The simplified Markgill pain questionnaire(SF-MPQ)was used to assess the degree of discomfort in patients.The expression levels of serum interferon(IFN)-γand interleukin(IL)-4 and IL-10 were detected by enzyme linked immunosorbent assay;the expression level of neuron specific enolase(NSE)in serum was detected by automatic electrochemiluminescence apparatus.Postoperative complications,such as masticatory muscle weakness and facial hypoesthesia,were recorded in both groups.Results Compared with those before treatment,VAS and SF-MPQ scores of the patients in both groups decreased significantly after treatment(P<0.01);the VAS and SF-MPQ scores in the combined group were significantly lower than those in the control group on the 7th and 180th days after treatment(P<0.05).The excellent and good rates of clinical efficacy in the combined group were significantly higher than those in the control group on the 14th and 180th days after treatment(P<0.05).The incidence of masticatory muscle weakness in the patients of the combined group was lower than those in the control group on 7th,14th,and 90th days after treatment,while the incidence of facial hypoesthesia in the patients of the combined group was lower than those in the control group at 14th and 90th days after treatment(P<0.05).Compared with those before treatment,the serum levels of IFN-γin both groups were significantly increased,while the levels of IL-4,IL-10,and NSE were significantly decreased(P<0.01);the serum level of IFN-γin the combination group after seven days of treatment was obviously higher than that of the control group,and the levels of IL-4,IL-10,and NSE were significantly lower than those in the control group(P<0.05).Conclusion Hyperbaric oxygen combined with temperature controlled thermocoagulation in the treatment of primary trigeminal neuralgia has a rapid and long effect,which can significantly reduce the degree of pain and discomfort in patients and reduce the degree of facial hypoesthesia and the incidence of complications such as masticatory muscle weakness.Thus,it is worthy of clinical application.